How To Use CPT Code 67036

CPT 67036 describes a specific procedure performed on the posterior segment of the eye known as vitrectomy. This article will provide an overview of CPT code 67036, including its official description, the procedure itself, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 67036?

CPT 67036 is a code used to describe a surgical procedure called vitrectomy. This procedure involves the removal of vitreous fluid from the eye in order to gain access to the posterior segment of the eye. The provider makes incisions in the pars plana, a darkly pigmented area of the ciliary body, to introduce surgical instruments and perform the necessary interventions.

2. Official Description

The official description of CPT code 67036 is: ‘Vitrectomy, mechanical, pars plana approach.’ This code specifically refers to the surgical removal of vitreous humor from the eye using a mechanical technique, with the incisions made in the pars plana region.

3. Procedure

1. The procedure begins with the patient being appropriately prepped and anesthetized.
2. The provider places a special contact lens on the patient’s cornea to aid in visualization.
3. Using vitrectomy equipment, the provider makes incisions in the pars plana to expose the sclera.
4. Three small incisions are made to insert a lighted cannula, an infusion cannula, and cutting and suction instruments.
5. The provider then removes the vitreous fluid from the eye, creating a posterior sclerotomy.
6. After completing the necessary interventions, the provider removes the instrumentation and closes the incision using sutures.
7. In some cases, a sterile solution may be injected into the eye to restore pressure, and a pressure patch with antibiotic ointment may be applied.

4. Qualifying circumstances

CPT 67036 is performed on patients who require surgical access to the posterior segment of the eye. This procedure is typically necessary when the vitreous humor needs to be removed due to certain conditions or complications. It is important to note that the procedure must be performed by a qualified healthcare professional who is trained in vitrectomy techniques.

5. When to use CPT code 67036

CPT code 67036 should be used when a vitrectomy is performed using a mechanical approach through the pars plana. It is important to accurately document the specific details of the procedure to ensure proper coding and billing.

6. Documentation requirements

Documentation for CPT code 67036 should include the following information:

• Reason for the vitrectomy and the need for surgical access to the posterior segment of the eye
• Details of the procedure, including the use of vitrectomy equipment and the specific techniques employed
• Date of the procedure and the duration of the surgery
• Any additional interventions performed during the procedure
• Post-operative care instructions and any complications encountered
• Signature of the healthcare professional performing the procedure

7. Billing guidelines

When billing for CPT code 67036, it is important to ensure that the procedure meets the specific criteria outlined in the code description. Additionally, it is crucial to follow any specific billing guidelines provided by insurance carriers or regulatory bodies. It is also important to note that there may be certain circumstances where CPT code 67036 should not be reported with other codes, so it is essential to review the guidelines and documentation requirements carefully.

8. Historical information

CPT code 67036 was added to the Current Procedural Terminology system on January 1, 1990. Since its addition, there have been no updates or changes to the code.

9. Examples

1. A patient undergoes vitrectomy using a mechanical, pars plana approach to repair a retinal detachment.
2. A provider performs vitrectomy with removal of preretinal cellular membrane for the treatment of a macular pucker.
3. A vitrectomy is performed to remove a subretinal membrane associated with choroidal neovascularization.
4. A patient undergoes vitrectomy with removal of the internal limiting membrane of the retina to repair a macular hole.
5. A provider performs vitrectomy with removal of preretinal cellular membrane and internal limiting membrane of the retina for the repair of a retinal detachment and macular hole.